Validation of a clinical prediction score for ruling out coronary heart disease in primary care patients with chest pain.

TitreValidation of a clinical prediction score for ruling out coronary heart disease in primary care patients with chest pain.
Publication TypeConference Paper
Year of Publication2009
AuthorsGencer, B, Vaucher, P, Boesner, S, Herzig, L, Verdon, F, Ruffieux, C, Burnand, B, Bischoff, T, Donner-Banzhoff, N, Favrat, B
Conference Name15th Wonca Europe Conference, Basel (Switzerland), 16-19 September 2009
ISBN Number1424-7860
Accession Numberserval:BIB_A4178EEC5E02
Mots-clésChest Pain, Coronary Disease/diagnosis, Predictive Value of Tests, Primary Health Care
Abstract

Background: A patient's chest pain raises concern for the possibility of coronary heart disease (CHD). An easy to use clinical prediction rule has been derived from the TOPIC study in Lausanne. Our objective is to validate this clinical score for ruling out CHD in primary care patients with chest pain.
Methods: This secondary analysis used data collected from a oneyear follow-up cohort study attending 76 GPs in Germany. Patients attending their GP with chest pain were questioned on their age, gender, duration of chest pain (1-60 min), sternal pain location, pain increases with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the curve (ROC), sensitivity and specificity of the Lausanne CHD score were calculated for patients with full data.
Results: 1190 patients were included. Full data was available for 509 patients (42.8%). Missing data was not related to having CHD (p = 0.397) or having a cardiovascular risk factor (p = 0.275). 76 (14.9%) were diagnosed with a CHD. Prevalence of CHD were respectively of 68/344 (19.8%), 2/62 (3.2%), 6/103 (5.8%) in the high, intermediate and low risk category. ROC was of 72.9 (CI95% 66.8; 78.9). Ruling out patients with low risk has a sensitivity of 92.1% (CI95% 83.0; 96.7) and a specificity of 22.4% (CI95% 18.6%; 26.7%).
Conclusion: The Lausanne CHD score shows reasonably good sensitivity and can be used to rule out coronary events in patients with chest pain. Patients at risk of CHD for other rarer reasons should nevertheless also be investigated.

Notes

oai:serval.unil.ch:BIB_A4178EEC5E02

URLhttp://www.smw.ch/docs/PdfContent/smw-12931.pdf
Citation Key / SERVAL ID5486

                         

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